摘要目的 回顾性分析转移性前列腺癌患者相关临床病理资料,寻找生存预后的预测因素,以指导临床实践.方法 自1998年3月至2009年6月收治前列腺癌患者940例,筛选出接受内分泌治疗并且具有完整临床病理资料的前列腺癌患者364例.对此364例患者进行随访并对生存预后进行分析,寻找生存预后的预测因子.采用SPSS 15.0统计软件,生存函数分析运用Kaplan-Meier 法,单因素和多因素分析运用Cox回归,并采用Log-rank法进行显著性检验.结果 末次随访时间为2009年6月30日,中位随访时间24(3～135)个月.末次随访时240例生存,109例死亡,15例失访.转移性前列腺癌的中位生存时间为64(3～135)个月,1、2、3、4、5年生存率分别为92%、78%、66%、60%、54%.单因素分析显示,Gleason评分、临床分期(M分期)、内分泌治疗有效性、内分泌治疗过程中血清前列腺特异抗原(PSA)最低值、达到PSA最低值时间为转移性前列腺癌生存时间的预后因素(均P＜0.05).多因素分析显示:内分泌治疗过程中PSA最低值和达到PSA最低值时间为转移性前列腺癌生存时间的独立预后因素(均P＜0.01).结论 内分泌治疗过程中PSA最低值和达到PSA最低值时间为转移性前列腺癌生存时间的独立预后因素.

abstractsObjectives To analyze the clinical and pathological informations of metastatic prostate cancer patients to find the predictive factors of the survival. Methods To filter 364 cases of metastatic prostate cancer in the 940 cases of prostate cancer that were treated in Cancer Hospital Fudan University in Shanghai from March 1998 to June 2009, the cases had hormonal therapy and full clinical and pathological records. All the 364 cases were followed up and the clinical and pathological informations were analyzed, to find the predictive factors that related to the prognosis. Statistic software SPSS 15.0 was used for analysis. Cumulative survival was analyzed by the method of Kaplan-Meier. Cox regression was used for univariate and multivariate analysis. Log-rank method was used for the significance test.Results The last follow-up date was 30th June 2009 and the median follow-up time was 24 months. At the final follow-up, 240 cases were alive, 109 cases were dead and 15 cases were lost to follow up. The median survival time of metastatic prostate cancer was 64 months, and the one-year, two-year, three-year, four-year, five-year survival rate was 92% , 78% , 66% , 60% , 54%. The univariate analysis indicated that Gleason score (P = 0. 033), clinical stage (P < 0. 001), the effectiveness of hormonal therapy (P < 0. 001), the prostate specific antigen (PSA) nadir during hormonal therapy (P <0. 001) and the time from the start of hormonal therapy to the PSA nadir ( P = 0. 002) were predictive factors for the survival time of metastatic prostate cancer. The multivariate analysis indicated that the PSA nadir during hormonal therapy (P < 0.001) and the time from the start of hormonal therapy to the PSA nadir (P <0. 001) were independent factors that predict the survival time of metastatic prostate cancer. Conclusion The PSA nadir during hormonal therapy and the time from the start of hormonal therapy to the PSA nadir are independent factors that predict the survival time of metastatic prostate cancer.